跨伤椎固定与经伤椎固定在胸腰椎骨折术中的应用效果比较

目的：比较跨伤椎固定与经伤椎固定治疗胸腰椎骨折的临床疗效。方法：回顾2010年3月-2013年12月本科收治的胸腰椎骨折患者98例，术中采取跨伤椎固定技术或经伤椎固定技术固定骨折，其中经伤椎体固定组54例，跨伤椎固定组44例。比较患者术前VAS疼痛评分、术前伤椎后凸角、手术时间、术中出血量、术后第1周VAS评分、术后1年伤椎后凸角及术后的并发症。结果：跨伤椎固定和经伤椎固定均可以减少VAS评分（P〈0．05），同时减少伤椎后凸角度（P〈0．05）。跨伤椎固定组与经伤椎固定组在术前及术后第1周2个时间点的vAS评分、手术时间、术后伤椎后凸角、术后总体并发症发生率方面差异均无统计学意义（P〉0．05）。跨伤椎固定组术中失血低于经伤椎固定组（P〉0．05），但内固定断裂风险高于经伤椎固定组（P〈0．05）。结论：跨伤椎固定与经伤椎固定两种手术方式固定胸腰椎骨折均能有效减轻术后疼痛，维持伤椎矫正度，但经伤椎固定技术的术后内固定失败率更低。

Effect of pedicle screw fixation across injured vertebra versus via injured vertebra on thoracolumbar fracture

Objective.. To compare the effect of pediele screw fixation across injured vertebra with via injured vertebra on thoracolumar fracture. Methods.. Clinical data of 98 patients who suffered from thoracolumbar fracture and underwent operation in our department from March 2010 to December 2013 were analyzed retrospectively. During the surgery, the thoracolumbar fracture was fixed with pedicle screw fixation across injured vertebra or via injured vertebra. Among them, 54 cases were in the group of via injured vertebra for thoracolumar fracture and the others in across injured vertebra group. Meanwhile, visual ana- logue scale （VAS） and vertebral kyphotic angle were recorded before and after the operations. The time of operation and the intraoperative blood loss also were recorded for comparing. Results： Both of them could reduce the points of VAS （P-0.05） and increase the vertebral kypotic angle （P%0.05）. There was no difference between the two groups in VAS, vertebral kyphotic angle, surgical time, rate of overall complications （P〉0.05）. The intraoperative time in via injured vertebra group were longer than those of the other group （P〈0.05）. However, pedicle screw across the injured vertebra fixation significantly increased the risk of breakage of internal fixation compared with via iniured vertebra fixation （P〈O. 05）. Conclusions.. Both pedicle screw via injured vertebra fixation and across injured vertebra fixation for throracolumbar fracture could ease pain and correet the injured vertebral kyphotic angle. The failure rate of internal fixation was lower with pediele screw via injured vertebra fixation.